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How Bad is aortic root dilation of 4.4 CM ? And questions I should ask.

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  • How Bad is aortic root dilation of 4.4 CM ? And questions I should ask.

    Hi
    I've done some searching and couldn't find anything quite like I'm asking. I'm a 63 year old type two diabetic. In my recent Echocardiagram report there was a listing that I had a focally calcified aortic valve with normal motion and moderate root dilation (4.4CM) with narrowing in the ascending aorta to a diameter of 3.3 cm. Naturally I'm quite nervous, but I've already taken comfort in comments from fine peope on this forum.
    My interninst recommended a repeat in 6 months, but since I had a lot of questions and he gave me the original result over the phone, I'm seeing a cardiologist on the 23rd. Are there specific questions I should ask? Any other tests I should ask for ? I did have the same test in 2007, at the same facility. Would it be any good to compare those results to the current one? Any advice would be appreciated.
    Thanks

  • #2
    There are many people here more expert in the technicalities of this than I am, and I'm sure they will be on before long.

    In the meantime, thought I should mention that my aortic root dimension going into surgery at age 63 was 5.3 cm. I had been monitored with 6-month echos, and at the end, 3-month ones. Had a combined aortic root and valve replacement. Doing fine now, more than 6 years later.

    The number most often mentioned as the target or trigger for surgery is 5.0, but of course that's a generality that may not apply in individual cases -- might be less, might be more. That's one thing you might want to ask about.

    Anyway, welcome the forum! Glad you found us, and hope you'll get some good insights here.
    Medtronics Freestyle Aortic Root Heart Valve (Porcine)
    02/16/05 Inova Fairfax, Virginia (Dr. Speir)
    www.steadfastdawgwalker.com (senior fitness blog)

    Comment


    • #3
      Welcome to VR.org, booklover. Happy you found us.

      You are wise to see a cardiologist and also wise to ask for a comparison of the previous echo. You need a cardio in addition to your PCP to review your echo and to answer your questions. You may even wish to consult a surgeon for his/her opinion after your meeting with the cardio.

      I can't help you with the specifics of your measurements but am sure someone will be along to help with that.

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      • #4
        Hi booklover. My cardiologist told me 5.0 cm is the point I would need my bav replaced. I have severe regurgitation. I think that might be the factor for me. My first echo last July was 4.1. My last echo in Jan was 3.3. I don't know why it shrunk. A lot of prayer. I also lost 20 lbs. Now at 5'8 and 136lbs. As far as questions. I will ask if they could see any aneurysms. what type of valve they recomend for you. What type of excersize you can do or not. (mine told me no heavy lifting but I could run until my heart rate was fast and then walk). Next time I will ask her what my max heart rate can be because I am running 3 miles a day now. My heart rate peaks at 160 ish. Sorry I can't help more but I am trying to figure this all out myself. I have been living in denial for the last few months. Good luck
        AVR on 09-13-2011. On-x 25mm
        Emory Midtown. Atlanta GA. Dr Guyton

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        • #5
          booklover,

          There are two different places that they generally measure the aortic root...at the annulus and at the proximal ascending aorta. My cardiologists always gave me both numbers as it was dilating and at surgery my numbers measured by CT scan just before my surgery were 5.4cm and 5.8cm. When my surgeon got in there he said they were slightly larger than even the CT scan measured.

          I would give you a rough estimate that the normal range can be anywhere from 2.2 to 3.6cm. I would agree that you have a moderately dilated aortic root. As Bob said 5.0cm is usually the trigger point for considering surgery but it varies from patient to patient and surgeon to surgeon. Another factor is how fast it is dilating. As you grow older your aortic root naturally grows larger but at a slow rate (1-2mm per year). I would definitely compare past echos to see if it seems to be accelerating at a faster rate as time goes on.

          Another question is your valve. It could be that your valve will need to be replaced before your aortic root. Which ever one reaches the point of needing replacement they will probably replace both at one time.

          Although an echo gives a decent view of the aortic root the best method for an accurate measurement is a MRI or a CT scan. I had all 3 done and got 3 different measurements with the echo being the smallest, the MRI in the middle, and the CT gave the largest measurements (and upon surgery the most accurate). My surgeon said the gold standard for getting the most accurate measurement is the CT scan. He gives all of his pre-op patients that are having root/ascending aorta surgery a CT scan before surgery and an annual MRI after surgery. Radiation is an issue with the CT scan which is why I think he uses the MRI for his annual checks. If he sees something that concerns him he would probably follow that up with a CT scan.

          Hope this helps somewhat. Don't be afraid to ask your cardiologist any questions you have and in as much detail as you can understand. That is what they are there for and they work FOR YOU.
          VSD Repair & Ross Procedure 3/17/04 - Dr. James Jaggers
          Bentall Procedure 2/22/11 - Dr. G Chad Hughes
          Both performed at Duke University Medical Center

          Comment


          • #6
            YEP, at 4.4 cm you are in the "Watch and Wait" category.

            It would be wise to establish a relationship with a good Cardiologist at this point and have regular EchoCardiograms (probably annually, maybe semi-annually) to watch for changes and the rate of change.

            FWIW, I transcribe my Echo Reports to a Spread Sheet for easy comparision.

            'AL Capshaw'

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            • #7
              I was 6.7 cm in the ascending aorta. Lucky it was caught!!!
              May 18, 2010 diagnosed with BAV, aortic aneurysm of 6.7cm. July 9, valve sparing aortic root replacement surgery by Dr. Boodhwani at the Ottawa Heart Institute. July 30, Medtronic Adapta ADDRL1 pacemaker inserted due to complete heart block after surgery.

              Comment


              • #8
                well i had a baby, then had another baby 1 year later. 5 days after that, my heart problem and aneurysm were discovered. it measured 4.8. they told me i was lucky to be alive after delivering 2 pregnancies.

                i was only 27 at the time! so i guess its serious, something to be aware of for sure!
                May 21st 2010- Aortic Valve Replacement w/ Arch Replacement
                Mild/Moderate Stenosis and Ascending Arch Aneurysm
                Diagnosed w/ Bi Cuspid Aortic Valve Feb. 2008

                Comment


                • #9
                  I had my surgery last july after knowing about my issue for about two months. i had an anyerism of 4.6cm (and that caused my valve to be leaking and in "sever" stage) according to the ct scan and for some reason i was really pushing for surgery right away. my surgean felt that we could hold off on the surgery but i am glad that i told him we had to do it "Really Soon!"

                  After my surgery he said that my aortic tissue was "paper thin" i am sure that if i kept working without haveing surgery then i prob would of died soon.(cardiologist said 2 months after the surgery that i would not of made it till then.)

                  The test can all vary and none of them are going to be "crystal" clear.

                  Good luck and i hope you the best!
                  St Jude AVR, Asend aorta replace, Rebuild the Root
                  7-1-10 St. Pats Missoula, MT
                  Dr Long and Dr Maxwell

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                  • #10
                    Superbob,
                    Thanks for your comments. I'll post again after I see the cardio.

                    Comment


                    • #11
                      Scott,
                      Thanks for the quick reponse. Good luck to you.

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                      • #12
                        My aorta was okay at the root, but dilated in the ascending aorta. That being said, my ascending aorta was 4.5cm for 9 years, with no movement over that time. However, then in a little over a year it went from 4.5 to 5.4cm, and it was time for me to have surgery. My doc seems to agree with the 5.0cm recommendation, saying that this was the trigger point for surgery. My valve was bicuspid from birth, so I had the aneurysm replaced as well as the valve. Hope this helps.
                        BAV...AVR March 7th, 2011 / Carbomedics mechanical 25mm
                        Ascending Aortic Aneurysm replaced with Dacron at same time
                        Sanford Heart, Fargo, ND, Dr. Roxanne Newman

                        Comment


                        • #13
                          Jason,
                          Everyone. Thanks for your comments. I appreciate the support. When I first heard this I was in a state of panic, but I see that it is something I can deal with. My father had an abdominal aneurism when he was in his seventies. And he heard about it from a doctor with a horrible bed side manner. The doctor came to him after the tests and basically said, "You've got an abdominal aneurism. We can't operate," and walked out. My father was devastated. We ended up seeing a great specialist at a teaching hospital here who explained everything. My dad died several years later, but not from the aneurism.
                          Thanks again to everyone. I'm seeing a cardiologist Monday the 23rd. I may have more questions after that visit, but I do appreciate the support from everyone now.

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